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. 2016 Aug;23(4):e362-8.
doi: 10.3747/co.23.3051. Epub 2016 Aug 12.

Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes on outcomes in lung stereotactic body radiotherapy

M Giuliani  1 , L R Sampson  1 , O Wong  1 , J Gay  1 , L W Le, B C J Cho  1 , A Brade  1 , A Sun  1 , A Bezjak  1 , A J Hope  1
Affiliations

Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes on outcomes in lung stereotactic body radiotherapy

M Giuliani et al. Curr Oncol. 2016 Aug.

Abstract

Purpose: In the present study, we determined the association of pretreatment circulating neutrophils, monocytes, and lymphocytes with clinical outcomes after lung stereotactic body radiotherapy (sbrt).

Methods: All patients with primary lung cancer and with a complete blood count within 3 months of lung sbrt from 2005 to 2012 were included. Overall survival (os) was calculated using the Kaplan-Meier method. Factors associated with os were investigated using univariable and multivariable Cox proportional hazards regression. Fine-Gray competing risk regression was performed to test the association of the neutrophil:lymphocyte (nlr) and monocyte:lymphocyte (mlr) ratios with two types of failure: disease-related failure and death, and death unrelated to disease.

Results: Of the 299 sbrt patients identified, 122 were eligible for analysis. The median and range of the nlr and mlr were 3.0 (0.3-22.0) and 0.4 (0.1-1.9) respectively. On multivariable analysis, sex (p = 0.02), T stage (p = 0.04), and nlr (p < 0.01) were associated with os. On multivariable analysis, T stage (p < 0.01) and mlr (p < 0.01) were associated with disease-related failure; mlr (p = 0.03), nlr (p < 0.01), and sbrt dose of 48 Gy in 4 fractions (p = 0.03) and 54 Gy or 60 Gy in 3 fractions (p = 0.02) were associated with disease-unrelated death. Median survival was 4.3 years in the nlr≤3 group (95% confidence interval: 3.5 to not reached) and 2.5 years in the nlr>3 group (95% confidence interval: 1.7 to 4.8; p < 0.01).

Conclusions: In lung sbrt patients, nlr and mlr are independently associated with os and disease-unrelated death. If validated, nlr and mlr could help to identify patients who would benefit most from sbrt.

Keywords: hemoglobin; lymphocytes; monocytes; neutrophils; outcomes; sabr; sbrt.

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Figures

FIGURE 1
FIGURE 1
Pre-treatment distribution of neutrophils, lymphocytes, monocytes, platelets, hemoglobin, and white blood cells (WBC).
FIGURE 2
FIGURE 2
Kaplan–Meier curves for overall survival by neutrophil: lymphocyte (NL) ratio (NLR).
FIGURE 3
FIGURE 3
Cumulative incidence of disease-unrelated deaths and disease-related failure. NL = neutrophils:lymphocytes.
See this image and copyright information in PMC

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